Tag Archives: Rehabilitation

The art of batting

The art of batting

With the cricket season about to begin, I thought it timely to use a batting metaphor to illustrate how thinking can obstruct free flowing movement. For the cricket lover, there is great joy watching a batsman lean into his front foot, head towards the ball, eyes focused through the grill, as the bat arcs guided by fast hands, the wood kissing the leather ball in the briefest of seconds before accelerating to the rope.

Seeing an expert perform in any field has the common denominator of ease. They make it look so natural and effortless, whether playing a musical instrument, dancing or stroke play. The movements have been rehearsed and honed thousands and thousands of times before, the motor patterns in the brain grooved with the synaptic efficiency that results from hours of practice.

Most people are ‘experts’ at walking. We don’t think about it in this way necessarily but the walk is a movement pattern that has been practiced since we started, well… walking. It is only when things go wrong does the motion change. A limp for example. Walking can also change when we start thinking about it rather than naturally, unobservedly going about our business of ambulation. Note how much activity is afoot from the simple stepping action, involving the whole body, the whole person and his or her mood and the environment in which the individual resides at that moment. Of course, the perception or even attention upon the environment is affected by one’s mood — ‘how did I get here? I didn’t even notice’.

With movement and posturing being an expression of who we are and what we are thinking and feeling, there are characteristic styles that identify us to others and to self — you will recognise a friend from afar by the way he walks; and you will know that you are moving well and normally by detecting self, or rather when the self feels different. When all is well, the act of walking is not noticed, yet as I have said, this changes at the point of being conscious of how the arms swing, the legs lift and the body sways, and if heavy or light thoughts crowd into the mind.

It is well known that the batsman must concentrate on the ball until the last: ‘watch the ball onto the bat’. This happens quickly and hence any unnecessary thought can affect the end result. ‘He looks quick’, or listening to the banter from behind the stumps, and oops, it could be the long march back to the pavilion. Some high quality players have in recent years been subject to depression, which has certainly affected their ability to hit the ball. Thoughts crowding in. The art of batting then, is a mindful task whereby the mind must be quiet to allow for the free flow of movement. There is no difference between this and movement on a day to day basis.

The person suffering chronic pain moves differently. The body is protecting itself, the individual consciously protects and hence simple movements, once take for granted, are now anticipated, planned and executed in a timid and fearful way. This pattern is encoded and passed back into the sensorimotor system to plan the next movement and other possible actions that the brain predicts may happen. Where this does not match the normal pattern, a threat value is created, evoking activity in the salient network that detects when something is physiologically amiss. Part of this network’s role is to trigger responses that motivate behaviours and attention to the relevant areas of the body. Once satisfied that all is well, protection is lifted and wellness ensues.

Movement is fundamental to health and feeling normal. We can tell when someone is not well in many cases by the way they move and hold themselves. To restore flow and ease of movement often requires that we target fears and anxieties that are caused by thoughts that can obscure. Much as the batsman needs clarity, so does the person overcoming pain. And whilst sometimes we need to think about the way we move, most times we just desire natural, unconscious and purposeful action that results in a reward.

In rehabilitation and in overcoming chronic pain, just like batting, we need a clear mind so that we can focus upon the job in hand. Thoughts come and go, but if we let them interfere with the action rather than letting them pass, there will not be the same result. Practicing mindful movements where you learn the skill of focused attention allows for the right kind of concentration and attention, eradicating the effects of fear and anxiety that can so commonly be associated with normal movements and activities. Understanding pain is another key element of reducing these fears and their potent effects.

To set up the right conditions for recovery, we must consider beliefs, thoughts and fears as well as the environment and the vision of where the person wants to be. From here we can create an individualised programme that addresses all dimensions of the pain experience: the physical, the cognitive and the emotional; and how theses dimensions interact. This is the complete and whole person approach to pain that is necessary and indicated by modern pain neuroscience.

For informationPain Coach Programme or to book onto the Pain Coach Programme, please call us on 07518 445493



Bono's injury

Bono’s arm

Bono's injuryAnyone who has read Bono’s recent post will know that he believes that he may not play his guitar again. As a rock and roll icon, this is a strong message that reveals the mortality of man.

Many times I have heard people tell me that they cannot do what they used to do. This is usually because of pain or a physical limitation. Often this pain and limitation has been in existence for some time before they come to see me, and hence the body has physically adapted, thinking has narrowed and avoidance assumes the default position. For this reason, the early messages about pain and injury are a vital because they set the scene for the action taken.

I do not know the full details about Bono’s arm aside from reports in the media. The injury sounded complex and nasty, requiring surgery to fix the damage. Healing always ensues, pain usually accompanies healing as do a range of other biological mechanisms such as change in movement, change in thinking and responses to different environments. Additionally we can feel unwell (the sickness response), our mood can vary, sleep is disrupted with knock-on effects, appetite may change and thinking can lose clarity. There is a very individual response to an injury, especially when it affects something very important to our self.

When helping patients to understand their pain I often tell them about the pain threshold differences in violinist’s hands — lower on the left because of the meaning of the left hand in terms of playing. If a carpenter cuts his finger, this may not be a great problem. It is certainly not unexpected. If a violinist cuts his left index finger, this could be a significant problem in terms of being able to play. Same type of injury, different meaning, therefore a different outcome: more pain, more negative thinking, more worry. This would be similar for a professional vs an amateur footballer who injures a knee ligament — the financial consequences, the loss of a place in the team etc.

The way in which Bono’s body responds to the injury will be unique to him, will reflect his health and the way he views his situation. This is the same for everyone. The uniqueness of the injury, the context, the environment and the person. For treatment and rehabilitation, this is how it must be viewed to optimise the outcomes.

Hypothetical case study

When a patient comes to see me with a complex injury, I focus on the person as much as the problem (this is one of my overarching principles). This is because it is the person who tells and lives their story, and it is the whole person I am treating, training and coaching back to a state of well-being.

Assessment would include:

  1. Exploring the narrative: gathering all the information about the injury — e.g./ the circumstances, how it happened, health status, lifestyle status, past experiences, beliefs about pain and injury
  2. Pain types: e.g. nociceptive inflammatory (possible neurogenic), neuropathic
  3. Protective measures that have been adopted: e.g./ guarding, avoidance
  4. Adaptations: e.g./ altered body sense, altered movement patterns
  5. Influences upon pain: stress, thoughts/beliefs, fatigue, emotions, other health factors, rumination

Then —

Pain understanding:

  1. This is the start point. Making sure that the person understands their pain, relevant to their condition and the action needed to overcome the pain.
  2. Getting their thinking in alignment with what we really know about pain and what it means to them to overcome pain. Achieving success is about the meaningful return to living; what is this to the patient?
  3. Cultivating the belief that their pain can be overcome and that they CAN do things with the right knowledge and ‘know how’. This is the pain coach concept.
  4. Develop the growth mindset — you may not be doing things YET; NOT YET rather than ‘I will never’. Never say never. Give it your best shot. Dedicate yourself to the fullest recovery and a return to wellbeing. Sign a contract stating this is need be, and know that you will be supported and motivated at every step.

Treatment & rehabilitation:

Depending upon the pain types (biology) and the influences upon pain, specific training is designed to achieving normal body sense, normal movement and confidence in being active and engaging in life again.

If playing the guitar is what they want to do, from word go that is how the training begins; even in plaster! Sensorimotor training begins immediately, or even before an operation. Working the sensorimotor areas is vital from a top-down perspective with specific exercises and can be started whilst immobilised with a range of imagery and visualisation techniques that work the motor centres.

When the immobilisation period ends, actual movement begins to nourish the stiffened, healing muscles and joints. After immobilisation it is normal for the area to appear different — perhaps red and swollen, a different skin quality, hair and nails can change too. Movement and sense of the area is altered and needs specific attention in the early stages because a normal perception of the body is key for healthy movement.

An early focus on function for a guitarist would include thinking and training dedicated to the fine control required to play. The actual movements are part of a sensorimotor feedforward-feedback loop that must be addressed. Adopting the right mindset is key for rehabilitation and should be practiced from the outset: a coaching model for a growth mindset.

We often do not know our full potential, so until you have given it your full dedicated attention, never say never.

Moving forward and changing pain

Never give up — a motivational talk

Diana Nyad swam 100 miles across a stretch of water between Cuba and Florida. She just kept going. The internal drive and the support that fuelled this drive kept her going in some of the most dangerous waters on the planet.

Rehabilitation and recovery from an injury or painful problem requires dedicated perseverance. But to optimise this perseverance we need to be motivated and inspired. We need to understand and know why; we need a purpose to drive us forward and keep moving forward. There are plateaus, flare-ups (when the symptoms and pain can increase), good days and bad days — life’s normal variation. Knowing why this happens, what we can do and why we are doing it keeps us moving forward.

Listen to Diana Nyed speak here about her experience and keeping going.

For information about our pain treatment programmes that are driven and inspired by neuroscience, explore the website and contact us on 07932 689081 to move forward

Turn 'no' into 'yes'

Too many cases of “I can’t” — the effects of persisting pain

Turn 'no' into 'yes'

Turn ‘no’ into ‘yes’

Frequently patients tell me at the first meeting that they cannot do x, y and z. Naturally, when something hurts we avoid that activity or action because pain is unpleasant. It hurts physically and mentally. In the acute stages of an injury or condition, it is wise to be protective as this is a key time for the tissues to heal, and although some movement is important for this process, too much can be disruptive. As time goes on, gradually re-engaging with normal and desirable activities restores day to day living. However, in some cases, in the early stages of pain and injury, the protection in terms of the thinking about the pain and subsequent behaviours becomes such that they persist beyond a useful time. The longer that this continues, the harder it becomes to break the habits.

Don’t feed the brain with “I can’t”, feed it with “I can” — cultivate the natural goal seeking and creative mechanisms of the brain

The vast majority of patients who come to the clinic have had their pain for months or years. I would like to have seen them earlier so as to break the habits of thought and action that are preventing forward movement. As a result of the longevity and severity of the pain, the impact factors, distress and suffering, a blend of experiences, expectations and thinking about the problem, it is common to slip gradually into a range of avoidances that are strongly linked with thoughts that “I can’t do …. or …..”. These thoughts may have been fuelled by messages from care providers.

As a general statement, most activities that someone avoids because they fear that it will be damaging or painful can be approached with specific strategies that address both the thinking about the activity and the actual task itself. Recalling that pain is a protective device, an emergent experience within the body in an area that is perceived to be under threat and requiring defence, by diminishing the threat we can change the pain. And there are many ways of doing this on an individual basis — as pain is an individual experience with unique features for that person.

One of the main aims of our contemporary approach is to ensure that the individual understands their pain and problem so that the fear and threat value dissolves away. This leaves a more confident person willing to engage in training that promotes normal activities and re-engagement with desired pass-times.

To learn how you can do this, call us now 07932 689081


Creating the right conditions to move forward

3 key points

1. Nothing happens in isolation.

2. We are designed to change, grow and develop.

3. Nothing is permanent.

Bearing these fundamental points in mind, we seek to create and then cultivate the right conditions so that we may move forward in life. In terms of rehabilitation, we also look to create the conditions to achieve wellness that manifests in an ability to perform at home, at work and on the field of play.

Nothing happens in isolation: we are on a continuous pathway with an underpinning genetic make up that is sculpted by our experiences and environment (epigenetics). So when we experience a pain or an injury, the immediate physiological and behavioural responses that so affect the pain perception, will be determined by what we know and by what our brain knows (we do not know all the things that our brain knows. Or our nose knows). When designing and implementing a training programme for a painful condition, this is an important principle as the patient will have a story leading to the point when they exercise that will determine the response including what they have done physically, how they are feeling and what they are thinking. Anticipation and expectation must be addressed.

We are designed to change: neuroplasticity is a feature of the neuroimmune system that allows us to learn and change. However, the mindset around this is key. We must understand the we can change and have a belief that it is possible in order to behave in a way that will promote forward movement in life. This must be addressed in any rehabilitation programme and indeed it may be that thinking needs to be ‘rehabilitated’ as well.

Nothing is permanent: the concept of impermanence comes from Buddhism. Nothing is permanent, even pain and other symptoms. They change as does our thinking, emotional state and body sense. We may not think it does and particularly in suffering on-going pain. However, the intensity, quality, location and nature of pain changes regularly and this is because the neuroimmune system is dynamic, ever-responding to the internal and external environments. This is why the context of the situation is so key in pain. We must think about this in rehabilitation: the context of the training.

In summary, the natural processes within the body are simply designed for us. To maximise their potential we must create the right conditions for these processes to act and this means considering the physical, cognitive and emotional dimensions of the pain experience and how they interact. A single leg squat is a single leg squat, but what is the person thinking about the single leg squat, have they done it before, will the brain consider it to be safe, where are they doing it, when are they doing it……..the list of considerations goes on. Lets consider them.

For further information about our treatment and training programmes or to book your first session, call us on 07932 689081


Two excellent talks for athletes

Both talks are inspiring and demonstrate courage, perseverance and motivation in the face of the enormous challenges that were presented. In performance and rehabilitation, mindset is a key determinant and in many cases several skills must be developed, including resilience and coping strategies.

In the first video, Janine Shepherd talks about her experience of recovery following a severe injury.

In the second, Aimee Mullins talks in 1998 about her record-setting career as a runner, and about her carbon-fiber prosthetic legs.

Call us now to find out about our comprehensive treatment and training programmes to tackle persisting pain, recurring injuries and chronic pain: 07932 689081


Rehabilitation of thinking – A key element in maximising performance

The rehabilitation journey following an injury must be traveled with full commitment and completed. Usually when we talk about rehabilitation, it is the exercises that are focused upon: the movement, the task, the goal and how much to do. Nothing wrong with this of course as the training parameters are important to understand the effects of the exercise and how to subsequently progress. An aspect that is vital, yet less frequently mentioned, is the thinking both behind the activity and that of the individual undertaking the training.

Each exercise must have a meaning that needs to be explained. Full understanding of how, when and why the particular task is being undertaken is vital for full engagement, both physically and cognitively. In addition we have to consider the context of the exercise including the time of the day, the environment, the mood of the participant, level of discomfort, general health factors and other variables. Being aware of these influences and how they affect performance permits accurate assessment of the outcomes and where to focus upon for future improvement. In essence it is a learning process similar to that of learning a language or a musical instrument. Feedback plays a key role via the trainer correcting movement verbally and physically, and other means including exercising in front of a mirror.

The thinking of the participant before engaging in the exercise, during and afterwards will have an impact on success and hence learning. We can call this his or her mindset. Carol Dweck talks about a fixed mindset which describes a thought pattern underpinned by inflexible beliefs: it is how it is, this is my lot, change does not happen etc. Clearly this thinking can limit success and progression. A growth mindset on the other hand, is characterised by a belief that we can learn, change and grow. This mindset is one I encourage and seek to nurture as part of moving forwards following an injury or in progressing with a painful condition. In essence we are designed to change and adapt to our environment and circumstances. Given the right opportunity, input, motivation and timeline, we can evolve and develop healthier notions and actions for life both physically and in thought.

In summary, rehabilitation is not about simply going through the motions of certain exercises. It is about taking the opportunity to grow and develop physically and cognitively. In many cases we have to address thinking that is affecting the rehabilitation process, for example, thoughts that would be of a fixed mindset. Working upon these with strategies can and often are as important as the physical activities for optimum outcome. Our comprehensive rehabilitation programmes encompass these details so that you can progress from pain to performance.


Manual therapy, pain and the immune system

Pain relief

As a physiotherapist I frequently use my hands to treat the joints and tissues. It comes with the territory, everyone expects hands-on therapy and it does helps to reduce tension and pain. Most likely, the pain relief from joint mobilisation is due to descending mechanisms that include those that are powered by serotonin and noradrenaline (see here). This is very useful to know as it tells us about the effects of passively moving joints and importantly permits wise selection of techniques to target the pain mechanisms. Building on the knowledge base, two very recent studies have identified some extremely interesting results.

Firstly, Martins et al. (2011) found that ankle joint mobilisation reduced pain in a neuropathic pain model in rats along with seeing the regeneration of nerve tissue and inhibition of glial cell activation (a blog will be coming soon that discusses the immune system in pain states) in the dorsal horn of the spinal cord. Secondly, Crane et al. (2012) looked at how massage helps reduce the pain of exercise-induced muscle damage in young males. Taking muscle biopsies they found that massaged subjects demonstrated attenuation of proinflammatory cytokines, key players in sensitisation. It was also noted that massage had no effect upon metabolites such as lactate – see below.

More research into the mechanisms that underpin the effects of hands-on therapy is needed despite the advancements in our understanding. The ability to focus treatment upon this understanding can only develop our effectiveness in treating pain. I am very optimistic about the movement forwards in pain and basic science, and how this can be applied  in our thinking with individual patients. The language is changing with the words ‘treatment’ being used rather than ‘management’, the latter of which can imply that one has reached their limit of improvement. This is exciting and more importantly, realistic when one considers therapies such as the graded motor imagery. We do not have treatments that work for all pains but we do have brains and body systems that are flexible, dynamic and can change if given the opportunity, the right stimulation within the right context on the background of good understanding. It is our duty to keep this rolling onwards and thinking hard about how to best use the findings such as those highlighted in this blog.

Pain. 2011 Nov;152(11):2653-61. Epub 2011 Sep 8.

Ankle joint mobilization reduces axonotmesis-induced neuropathic pain and glial activation in the spinal cord and enhances nerve regeneration in rats.

Martins DF, Mazzardo-Martins L, Gadotti VM, Nascimento FP, Lima DA, Speckhann B, Favretto GA, Bobinski F, Cargnin-Ferreira E, Bressan E, Dutra RC, Calixto JB, Santos AR.


Laboratório de Neurobiologia da Dor e Inflamação, Departamento de Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, Florianópolis, SC, Brazil.


An important issue in physical rehabilitation is how to protect from or to reduce the effects of peripheral nerve injury. In the present study, we examined whether ankle joint mobilization (AJM) would reduce neuropathic pain and enhance motor functional recovery after nerve injury. In the axonotmesis model, AJM during 15 sessions every other day was conducted in rats. Mechanical and thermal hyperalgesia and motor performance deficit were measured for 5 weeks. After 5 weeks, we performed morphological analysis and quantified the immunoreactivity for CD11b/c and glial fibrillary acidic protein (GFAP), markers of glial activation, in the lumbar spinal cord. Mechanical and thermal hyperalgesia and motor performance deficit were found in the Crush+Anesthesia (Anes) group (P<0.001), which was significantly decreased after AJM (P<0.001). In the morphological analysis, the Crush+Anes group presented reduced myelin sheath thickness (P<0.05), but the AJM group presented enhanced myelin sheath thickness (P<0.05). Peripheral nerve injury increased the immunoreactivity for CD11b/c and GFAP in the spinal cord (P<0.05), and AJM markedly reduced CD11b/c and GFAP immunoreactivity (P<0.01). These results show that AJM in rats produces an antihyperalgesic effect and peripheral nerve regeneration through the inhibition of glial activation in the dorsal horn of the spinal cord. These findings suggest new approaches for physical rehabilitation to protect from or reduce the effects of nerve injury.


Sci Transl Med. 2012 Feb 1;4(119):119ra13.

Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage.

Crane JD, Ogborn DI, Cupido C, Melov S, Hubbard A, Bourgeois JM, Tarnopolsky MA.


Department of Kinesiology, McMaster University, Hamilton, Ontario L8S 4L8, Canada.


Massage therapy is commonly used during physical rehabilitation of skeletal muscle to ameliorate pain and promote recovery from injury. Although there is evidence that massage may relieve pain in injured muscle, how massage affects cellular function remains unknown. To assess the effects of massage, we administered either massage therapy or no treatment to separate quadriceps of 11 young male participants after exercise-induced muscle damage. Muscle biopsies were acquired from the quadriceps (vastus lateralis) at baseline, immediately after 10 min of massage treatment, and after a 2.5-hour period of recovery. We found that massage activated the mechanotransduction signaling pathways focal adhesion kinase (FAK) and extracellular signal-regulated kinase 1/2 (ERK1/2), potentiated mitochondrial biogenesis signaling [nuclear peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α)], and mitigated the rise in nuclear factor κB (NFκB) (p65) nuclear accumulation caused by exercise-induced muscle trauma. Moreover, despite having no effect on muscle metabolites (glycogen, lactate), massage attenuated the production of the inflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) and reduced heat shock protein 27 (HSP27) phosphorylation, thereby mitigating cellular stress resulting from myofiber injury. In summary, when administered to skeletal muscle that has been acutely damaged through exercise, massage therapy appears to be clinically beneficial by reducing inflammation and promoting mitochondrial biogenesis.


Chronic pain in sport – Specialist Clinic in London

Chronic pain is a real problem in the sporting world. The effects of not being able to participate are far reaching, especially when sport is your profession. There are a huge numbers of clinics offering treatments to deal with pain and injury and in many cases the problem improves. However, there are those who do not progress successfully, resulting in on-going pain, failed attempts to return to playing and varied responses to tissue-based treatment (manual therapy, injections, surgery etc). Understanding more about pain and how your body (brain) continues to protect itself is a really useful start point in moving forwards if you have become stuck. We know that gaining knowledge about the problem can actually improve a clinical test and the pain threshold.

When we injure ourselves playing sport the healing process begins immediately. Chemicals released by the tissues and the immune system are active locally, sealing off the area, dealing with the damaged tissue and setting the stage for rebuilding and repair. The pain asscociated with this phase is expected, normal and unpleasant. It is the unpleasantness that drives you to behave in a protective manner, for example limp, seek advice and treatment. Again, that is normal. Sometimes we can injure ourselves and not know that we have damaged the tissues. There are many stories of this happening when survival or something else is more important. This is because pain is a brain (not mind or ‘in the head’) experience 100% of the time. The brain perceives a threat and then protects the body. If no threat is perceived or it is more important to escape or finish the cup final, the brain is quite capable of releasing chemicals (perhaps 30 times more powerful than morphine) to provide natural pain relief. We know that pain is a brain experience because of phantom limb pain, a terrible situation when pain is felt in a limb that no longer exists. The reason is that we actually ‘feel’ or ‘sense’ our bodies via our virtual body that is mapped out in the brain. This has been mapped out by some clever scientists and in more recent years studies intensely using functional MRI scans of the brain.

Unfortunately, the brain can continue to protect the body with pain and altered movement beyond the time that is really useful. Changes in the properties of the neurons in the central nervous system (central sensitisation) mean that stimuli that are normally innocuous now trigger a painful response as can those outside of the affected area. One way to think about this functionality is that the gain or volume has been turned up, and we know that much of this amplification occurs in the spinal cord, involving both neurons and the immune system. Neurogenic inflammation can also be a feature, where the C-fibres release inflammatory chemicals into the tissues that they supply. On the basis that the brain is really interested in inflammation, even a small inflammatory response can evoke protective measures. Changes in the responsiveness of the ‘danger’ system as briefly described, underpin much of the persisting sensitivity. Altered perception is a further common description, either in the sense that the area is not controlled well or feels somewhat different – see here.

As the problem persists, so thinking and beliefs about the pain and injury can become increasingly negative. Unfortunately this can lead to behaviours that do not promote progression. Avoidance of activities, fear of movement, hypervigilance to signals from the body and catastrophising about the pain are all common features, all of which require addressing with both pain education and positive experiences to develop confidence and deeper understanding. An improvement in the pain level is a great way of starting this process, hence the importance of a tool box of therapies and strategies that target the pain mechanism(s) identified in the assessment.

Experience and plenty of scientific data describe the integration of body, brain and mind. This can no longer be ignored. It is fact. The contemporary biobehavioural approach to chronic and complex pain addresses the pain mechanisms, issues around the problem and the influencing factors in a biopsychosocial sense:

  • Biology: e.g./ physiology of pain, body systems involved in protection, tissue health
  • Psychology: e.g./ fears, anxiety, beliefs about the pain, thinking processes, outlook, coping, past experiences
  • Social: e.g./ work effects, effect upon the family, socialising, role of significant others (spouse, family), financial considerations

Specialist Clinic in London and Surrey for chronic pain and injury in sport – call 07518 445493

Chronic pain and injury requires an all-encompassing biobehavioural approach. Although the end aims can be different, the structure and themes within the treatment programme are similar to those that tackle any chronic pain issue. Bringing these principles into the sports arena, we can incorporate traditional models of care and advance beyond the tissue-based strategies to a way of working that addresses the source of the problem alongside the influencing factors that are slowing or even preventing recovery.

If you as a player are struggling to move forwards or have a player on your team who is not recovering or failing to respond as expected to treatment, we would be very pleased to help you. Call 07518 445 493 or email [email protected] for further infomartion about the clinics:

The Specialist Pain Physio Clinics work closely with the very best Consultants and can organise investigations such as MRI scans and x-rays with reports rapidly, an on-site at the New Malden Diagnostic Centre, 9 Harley Street and in Chelsea.


Can’t get over that skiing injury?

To the skier, the thought of watching friends and family clumping off in their boots towards the lift whilst sitting with a leg up, packed with ice and the daily paper, is intensely frustrating. Injuries happen. In many cases with the right early treatment, perhaps surgery and definitely a thorough rehabilitation programme, the symptoms resolve and the leg works again, good as new. However, there are a number of cases when this does not follow suit and the pain and limitations continue. There are reasons for this occurrence and they extend beyond the health of the tissues that almost always go through a healing process.

There are some complex mechanisms at play in the nervous and immune systems that are really useful when we first have an injury. This of course includes pain that is part of the way the brain defends the body when we damage ourselves. The way in which we go about protecting and treating ourselves is driven in part by the pain that motivates these actions: rest, seek advice or take analgesia. That is what pain really is, a motivator to take action to promote healing and survival. In the early stages of having injured tissues, often ligaments at the knee, this is really useful and important. Briefly, the damaged tissues release chemicals that sensitise the local nerve endings, stimulating a volley of danger signals to be sent to the spinal cord. Here, secondary neurons send this information to the brain for scrutiny. On deeming there to be a threat, the brain engages protective responses including pain, changes in movement and healing. Sometimes we can injure our tissues and the brain decides that something else is more important, perhaps escaping from the mountain, and will send signals down to the spinal cord to interfere with those coming from the tissues. The end result is the feeling of no pain and therefore you can take yourself to safety. Then it can start hurting. All in all, the responses will vary as will our ability to cope.

The early bombardment of the spinal cord and brain with danger signals that can also be influenced by the context of the injury, e.g. really scary, leads to changes in the properties of the neurons in the spinal cord. This means that subsequent signals can be amplified. It also means that normal signals (e.g. light touch) can start to provoke a painful response as can areas not directly involved. In the latter case one can find that the area of pain grows (click here). The on-going activity in the nervous system and other systems such as the immune system, endocrine system and autonomic system underpin the experience of persisting pain and protection, including altered movement that is so important to normalise.

In the case that the problem persists, the treatment is different. The tissues are addressed as one would expect with manual therapy, massage and other local treatments. However, alongside these traditional techniques are a range of strategies and treatments that are based upon the latest pain sciences that target the changes aforementioned and others. These strategies target the mechanisms at play and at source reduce the threat and hence the pain, normalise motor control and sensation of the affected area and restore function so that there can be a progression back to pre-injury activities.

For further information please contact the clinic: 07518 445493